These fractures can occur after trauma, but are also often observed in patients with osteoporosis, a condition of compromised bone strength, and referred to as osteoporotic compression fractures. Relative risk reduction in vertebral fracturesĪntiresorptives inhibit osteoclasts by inducing apoptosisĥ mg per day (prevention) or 35 mg per week (treatment)ĥ0% in patients with history of fracture 48% in those withoutĥ mg intravenously every two years (prevention) or 5 mg intravenously per year (treatment)ĥ0 to 100 IU per day intramuscularly or 200 IU per day intranasallyĠ.3 mg or 0.Spinal compression fractures are a type of spine fracture where the vertebral body becomes compressed or shortened. Denosumab can be used as an alternative to other therapies for the primary prevention of VCFs in postmenopausal women with osteoporosis. 6, 42 Additionally, denosumab (Prolia) leads to a relative decrease in new VCFs compared with placebo in postmenopausal women with osteoporosis. 6 The anabolic agent teriparatide (Forteo) reduces the risk of subsequent VCFs, although it is expensive and must be administered by daily subcutaneous injection. 6, 22, 40, 41 Although estrogen therapy has been approved for the prevention of osteoporosis, it should be considered only after nonestrogen treatments have been tried. Multiple bisphosphonates are approved for the primary and secondary prevention of VCFs. Food and Drug Administration for the treatment and prevention of osteoporosis include bisphosphonates, calcitonin, estrogen, selective estrogen receptor modulators, parathyroid hormone, and receptor activator of nuclear factor kappa-B ligand inhibitors 6 ( Table 2 3, 8, 34, 36, 37, 39 – 41 ). Family physicians can help prevent vertebral fractures through management of risk factors and the treatment of osteoporosis.ĥ00 to 1,000 mg every four to eight hours (maximum 3 g per day)Īnalgesic-associated nephropathy (chronic), anemia, hepatotoxicity, hypersensitivity, renal tubular necrosis (acute), skin reactions, thrombocytopeniaĪnorexia, dizziness, flushing, gastrointestinal disturbance, headache, hypertension, hypocalcemia, rash, rhinitis (intranasal), weight gainĭermatitis, edema, exacerbation of pain, skin depigmentation, urticariaĪbuse, anticholinergic effects, dependence, dizziness, sedation, serotonin syndrome when combined with other serotonergic medicationsĪddiction, cognitive impairment, constipation, delirium, dizziness, hypogonadism, nausea, opioid-induced hyperalgesia, pruritus, respiratory depression, somnolence, urine retentionĪtrial fibrillation, bleeding, cardiovascular disease, edema, gastritis, gastrointestinal bleeding, heart failure, hypertension, kidney disease, peptic ulcers Percutaneous vertebral augmentation, including vertebroplasty and kyphoplasty, is controversial, but can be considered in patients with inadequate pain relief with nonsurgical care or when persistent pain substantially affects quality of life. Other conservative therapeutic options include limited bed rest, bracing, physical therapy, nerve root blocks, and epidural injections. Physicians must be mindful of medication adverse effects in older patients. Acute VCFs may be treated with analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, narcotics, and calcitonin. More than two-thirds of patients are asymptomatic and diagnosed incidentally on plain radiography. Physical examination findings are often normal, but can demonstrate kyphosis and midline spine tenderness. Patients with an acute VCF may report abrupt onset of back pain with position changes, coughing, sneezing, or lifting. VCFs can lead to chronic pain, disfigurement, height loss, impaired activities of daily living, increased risk of pressure sores, pneumonia, and psychological distress. Fracture risk increases with age, with four in 10 white women older than 50 years experiencing a hip, spine, or vertebral fracture in their lifetime. Vertebral compression fractures (VCFs) are the most common complication of osteoporosis, affecting more than 700,000 Americans annually.
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